Telerehabilitation: What Patients Should Know
May 7, 2020
Nancy Littke, PT
In an effort to flatten the curve, Albertan’s access to in-person health-care services, including physiotherapy, have been limited. In an effort to provide much needed physiotherapy, many clinics and physiotherapists have turned to technology, adding telerehabilitation to their clinic services. Even as the province begins to re-open, it is expected that the option to receive services via telerehabilitation will continue.
So, what is telerehabilitation?
Telerehabilitation or telehealth is a virtual visit that uses specialized software and technology to deliver physiotherapy to clients. These visits can take place over the phone, communicating via email/text, but using a video conferencing platform is the most common tool used by physiotherapists.
How does it work?
As with an in-person visit, your physiotherapist will begin your assessment by asking questions about how and when your symptoms began, how you are feeling now, and what makes you feel better or worse. This helps them understand why you are seeking treatment and identify the goals you want to achieve. Several tests may be performed to determine the source of your symptoms. A treatment plan is then developed that usually includes exercises as homework.
When you are seeking online treatment, your physiotherapist takes an extra step to make sure that treatment via telerehabilitation is appropriate. There may be some tests they cannot do virtually, but many telerehab platforms enable them to measure your movement, provide information about your condition and how to manage it, and demonstrate exercises and watch you perform them to make sure you are doing your exercises correctly. Your physiotherapist may give you instructions on how to apply a hot pack or ice at home to help manage pain or inflammation. You may receive links to videos or pictures/diagrams to help you to continue with the exercise or activity program as homework between treatment sessions. Similar to a face-to-face visit, your physiotherapist will provide education to help you understand how much, how often, and how hard you should do your exercises, answer your questions, use tools for tracking your progress, and much more.
Isn’t telerehabilitation just something used to manage patients during COVID-19?
Even before COVID, telerehabilitation was an option open to physiotherapists and has been used to provide physiotherapy across the province and around the world for several years.
Physiotherapy provided through a virtual visit can improve access to care if you live in rural or remote communities. You or your local physiotherapist can connect to other clinicians with additional skills or expertise that cannot be provided locally. Telerehabilitation can connect clients with the specialist services they require without the barrier of long-distance travel, the added costs of seeking care outside your local setting or being placed on long waitlists.
Is telerehabilitation appropriate for everyone and every condition?
No. Although there are many conditions that can be appropriately managed by virtual appointments, some treatments cannot be provided without an in-person visit. Treatments that require direct interactions between physiotherapists and their client such as using needles, performing joint manipulation and mobilization cannot be provided at a distance. However, many conditions such as low back pain, recovery after total joint replacements or cast removal, or sprains and strains are well suited to a virtual setting as research shows these conditions are often better treated through education, exercise, and self-management. Chronic pain conditions may also be well managed through telerehabilitation.
Your physiotherapist will discuss your needs and do an initial screening assessment to determine if your specific situation is appropriate for telerehabilitation. They will also identify if there are barriers or reasons that virtual treatment sessions will not work well for you. Some things they may consider are:
- Do you have access to the resources needed such as internet, computers, tablets, or smartphones?
- Are you comfortable using technology?
- Are there any visual, hearing, or other mobility challenges that would limit your ability to participate in a virtual appointment?
- If required, do you have a caregiver or other individual who can participate in the sessions with you to provide assistance, perform some treatments with the physiotherapist’s guidance or ensure your safety as you perform exercises or activities?
Are there risks associated with telerehabilitation?
There are risks with any treatment provided by physiotherapists. Prior to agreeing to treatment, you should expect to be informed of the risks and benefits associated with treatment, and the risks of not receiving treatment. The expectation that your physiotherapist obtains your informed consent before assessing or treating you is no different when the treatment is provided virtually. You can expect your physiotherapist to explain what they have found and the treatment they recommend to meet your goals. However, they also need to identify things that could go wrong specific to telerehabilitation and discuss the strategies in place to ensure your safety.
Risks that must be managed differently when providing virtual physiotherapy care include:
Security of personal health information
Physiotherapists are always required to ensure the privacy and security of your personal information. However, when treatment is provided electronically the risk of a privacy breach may increase. Your physiotherapist should provide you with a privacy statement that outlines what they are doing to protect your personal information. They should also be providing advice on what you can do at your end to help protect private information. Ask questions if you are unsure.
There is also the risk of technology failure or service interruption. Are there strategies in place to ensure you can continue your treatment session with your physiotherapist if the internet goes down or your computer locks up? Do you have an alternate way to reach your physiotherapist if an online session fails or disconnects?
Physiotherapists are required to ensure the safety of their patients and put procedures in place to manage emergencies or unforeseen situations that may arise during a telerehabilitation session. Your physiotherapist may recommend that your treatment proceed in the presence of another health provider or a family member to enhance the safety and value of the visit. They should also outline what strategies are in place to assist you if you suffer an injury or medical emergency during your session.
Will my insurance company pay for telerehabilitation sessions?
There will be costs associated with your sessions. You must be made aware of the costs before you start treatment. You should confirm that any third-party benefit plans or insurers will cover the costs of telerehabilitation physiotherapy services before you begin. You do not want any surprises later if your claim has been denied. This is new terrain for insurers too, but many have already agreed to pay for these services and others have been joining in as time passes.
Receiving physiotherapy through telerehabilitation may be a new way of providing care, but it is not a new physiotherapy. Physiotherapists must comply with their professional Standards of Practice regardless of where or how they deliver physiotherapy services. You should expect the same quality of care and to receive safe, effective, and appropriate treatment to address your needs whether you are being seen in person, through telerehabilitation or a combination of both.
Remember, telerehabilitation may be a new experience. If you are unsure if it is right for you – ask questions before you embark on this path. Do not be afraid to give it a try. You may be pleasantly surprised by how much you and your physiotherapist can accomplish in your virtual treatment sessions!